COVID-19 and the occupational stress experienced by health professionals in the hospital context: integrative review

Costa, Natalí Nascimento Gonçalves; Servo, Maria Lúcia Silva; Figueredo, Wilton Nascimento

doi:10.1590/0034-7167-2020-0859

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 75 (Suppl 1) • 2022 • https://doi.org/10.1590/0034-7167-2020-0859 copy

COVID-19 and the occupational stress experienced by health professionals in the hospital context: integrative review

COVID-19 y estrés ocupacional experimentados por profesionales de la salud en el contexto del hospital: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze Brazilian and international scientific publications about the stress experienced by health professionals in the hospital context during the COVID-19 pandemic.

Methods:

Integrative literature review carried out on the SciELO, ScienceDirect, and LILACS databases, and sources of official Brazilian institutions, with documents published by May 2020.

Results:

Of the 26 selected references, 19 (73.08%) were indexed articles, and 7 (26.92 %) were obtained from official institutions. The study found that stress is mainly due to the overload of hospital services, the removal of professionals, the insufficiency of personal protective equipment and strict biosecurity measures, challenges in the allocation of available resources, and the risk of contamination by COVID-19.

Final considerations:

The stress experienced by health professionals in hospital institutions during the pandemic can trigger occupational and psychological problems.

Descriptors:
COVID-19; Health Personnel; Occupational Stress; Hospitals; Mental Health

Database	Search strategy	Results
ScienceDirect	(Coronavirus infections AND Health personnel)	1,039
LILACS	(Occupational stress AND Health personnel)	112
SciELO	(Occupational and personal health stress)	58
SciELO	(Coronavirus infections and health personnel)	259
TOTAL		1,468

Title/Reference	Year/Country	Design or approach/Number of participants	Interventions	Outcomes or mains results
COVID-19 and hospitalizations for SARS in Brazil: a comparison up to 12^nd epidemiological week 2020(¹⁵15 Bastos LS, Niquini RP, Lana RM, Villela DAM, Cruz OG, Coelho FC, et al. COVID-19 and hospitalizations for SARI in Brazil: a comparison up to the 12th epidemiological week of 2020. Cad Saude Publica. 2020;36(4):e00070120. https://doi.org/10.1590/0102-311X00070120 https://doi.org/10.1590/0102-311X0007012... )	2020 Brazil	Analysis Descriptive / Does not apply	Does not apply	In 2020, hospitalization for SARS exceeded that observed in the same period in each of the previous ten years. The age group above 60 years was the most affected, above the historical level.
Occupational psychosocial risks of health professionals in the face of the crisis produced by the COVID-19: From the identification of these risks to immediate action(¹⁶16 Blanco-Donoso LM, Garrosa E, Moreno-Jiménez J, Gálvez-Herrer M, Moreno-Jiménez B. Occupational psychosocial risks of health professionals in the face of the crisis produced by the covid-19: from the identification of these risks to immediate action. Int J Nurs Stud Adv. 2020:100003. https://doi.org/10.1016/j.ijnsa.2020.100003 https://doi.org/10.1016/j.ijnsa.2020.100... )	2020 Spain	Undefined / Does not apply	Does not apply	Identification of psychosocial risk factors and urgent protective measures that must be taken in psychosocial protection for health professionals
Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis(¹⁷17 Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the covid-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020:88:901-7. https://doi.org/10.1016/j.bbi.2020.05.026 https://doi.org/10.1016/j.bbi.2020.05.02... )	2020 United Kingdom	Systematic review and meta-analysis / Does not apply	Does not apply	Studies indicate a prevalence of anxiety of 23.2%; depression, 22.8%; and insomnia, 38.9%.
A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory(¹⁸18 Yin X, Zeng L. A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory. Int J Nurs Sci. 2020;7(2):157-60. https://doi.org/10.1016/j.ijnss.2020.04.002 https://doi.org/10.1016/j.ijnss.2020.04.... )	2020 China	Cross-sectional study/ n = 10	Does not apply	The needs of existence were the main ones during the epidemic, with the demands of health and safety influencing each other. The humanistic needs of concern were the most important.
Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses(¹⁹19 Ippolito M, Vitale F, Accurso G, Iozzo P, Gregorettin C, Giarratano A, et al. Medical masks and Respirators for the protection of healthcare workers from SARS-CoV-2 and other viroses. Pulmonology. 2020:26(4):204-12. https://doi.org/10.1016/j.pulmoe.2020.04.009 https://doi.org/10.1016/j.pulmoe.2020.04... )	2020 Italy	Literature review / Does not apply	Does not apply	Clinical evidence on the use of respirators is weak. The use of appropriate PPE is of crucial importance for healthcare professionals in the care of COVID-19 patients.
Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations(²⁰20 Phua J, Weng L, Ling L, Egi M, Lim C-M, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (covid-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506-17. https://doi.org/10.1016/S2213-2600(20)30161-2 https://doi.org/10.1016/S2213-2600(20)30... )	2020 Singapore	Literature review / Does not apply	Does not apply	Overview of challenges and recommendations in ICU clinical management
Mental health impacts and psychological interventions in the face of the New Coronavirus pandemic (COVID-19)(²¹21 Schmidt B, Crepaldi MA, Bolze SDA, Neiva-Silva L, Demenech LM. Saúde mental e intervenções psicológicas diante da pandemia do novo coronavírus (covid-19). Estud Psicol. 2020;37:e200063. https://doi.org/10.1590/1982-0275202037e200063 https://doi.org/10.1590/1982-0275202037e... )	2020 Brazil	Narrative review of literature / Does not apply	Does not apply	Identification of priority groups and guidance on psychological interventions
Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: a cross-sectional survey(²²22 Zhang X, Jiang Z, Yuan X, Wang Y, Huang D, Hu r, et al. Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (covid-19) epidemic: a cross-sectional survey. Int J Nurs Stud. 2020;103635. https://doi.org/10.1016/j.ijnurstu.2020.103635 https://doi.org/10.1016/j.ijnurstu.2020.... )	2020 China	Cross-sectional study/ n = 109	Does not apply	The actual length of the shift exceeded the preferred working hours of the nurses.
A qualitative study on the psychological experience of caregivers of COVID-19 patients(²³23 Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of caregivers of covid-19 patients. Am J Infect Control. 2020;48(6):592-8. https://doi.org/10.1016/j.ajic.2020.03.018 https://doi.org/10.1016/j.ajic.2020.03.0... )	2020 China	Phenomenological study/ n = 20	Does not apply	In the early days, negative emotions were dominant, and positive emotions appeared simultaneously or gradually.
Implications for COVID-19: a systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic(²⁴24 Fernandez R, Lord H, Halcomb E, Moxham L, Middleton R, Alananzeh I, et al. Implications for covid-19: a systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. Int J Nurs Stud. 2020;111:103637. https://doi.org/10.1016/j.ijnurstu.2020.103637 https://doi.org/10.1016/j.ijnurstu.2020.... )	2020 Australia	Systematic review / Does not apply	Does not apply	Three results were generated based on the categories: nursing teams supporting the provision of quality care; recognizing the physical and emotional impact; and responsiveness of the systematized organizational reaction.
Mental health problems faced by healthcare workers due to the COVID-19 pandemic - A review(²⁵25 Spoorthy M, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic: a review. Asian J Psychiatr. 2020;51:102119. https://doi.org/10.1016/j.ajp.2020.102119 https://doi.org/10.1016/j.ajp.2020.10211... )	2020 India	Literature review / Does not apply	Does not apply	Sociodemographic variables were associated with increased stress, anxiety, depressive symptoms and insomnia in health professionals. COVID-19 can be an independent risk factor for stress in health professionals.
Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross-sectional study(²⁶26 Kang L, Ma S, Chen M, Yang J, Wanga Y, Lia R, et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross-sectional study. Brain Behav Immun. 2020;87:11-7. https://doi.org/10.1016/j.bbi.2020.03.028 https://doi.org/10.1016/j.bbi.2020.03.02... )	2020 China	Cross-sectional study/ n = 994	Does not apply	Of the participants, 36.9% had mental health disorders below the threshold; 34.4%, mild disorders; 22.4%, moderate disorders; and 6.2% had severe disorders immediately after the viral epidemic.
The experiences of healthcare providers during the COVID-19 crisis in China: a qualitative study(²⁷27 Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care providers during the covid-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790-8. https://doi.org/10.1016/S2214-109X(20)30204-7 https://doi.org/10.1016/S2214-109X(20)30... )	2020 China	Phenomenological study/ n = 13	Does not apply	Three thematic categories emerged: being fully responsible for the well-being of patients - “this is my duty;” challenges of working in covid-19 wards; and resilience amid challenges.
Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China(²⁸28 Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding covid-19 among healthcare workers in Henan, China. J Hosp Infect. 2020;105(2):183-7. https://doi.org/10.1016/j.jhin.2020.04.012 https://doi.org/10.1016/j.jhin.2020.04.0... )	2020 China	Cross-sectional study/ n = 1,387	Does not apply	Of the health professionals interviewed, 89% had sufficient knowledge of COVID-19, more than 85% feared self-infection by the virus, and 89.7% followed the correct practices concerning COVID19.
A cross-sectional study on mental health among health care workers during the outbreak of Corona Virus Disease 2019(²⁹29 Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of corona virus disease 2019. Asian J Psychiatr. 2020;51:102111. https://doi.org/10.1016/j.ajp.2020.102111 https://doi.org/10.1016/j.ajp.2020.10211... )	2020 China	Cross-sectional study/ n = 1,521	Does not apply	The results showed that people without experience in public health emergencies performed worse in mental health, resilience, and social support.
A multinational, multicenter study on the psychological outcomes and associated physical symptoms among healthcare workers during COVID-19 outbreak(³⁰30 Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559-65. https://doi.org/10.1016/j.bbi.2020.04.049 https://doi.org/10.1016/j.bbi.2020.04.04... )	2020 Singapore	Multinational and multicenter study/ n = 906	Does not apply	Of the participating health professionals, 48 (5.3%) had a positive screening for moderate to very severe depression; 79 (8.7%) for moderate to extremely severe anxiety; 20 (2.2%) for moderate to extremely severe stress; and 34 (3.8%) for moderate to severe levels of psychological distress.
Unraveling potential severe psychiatric repercussions on healthcare professionals during the COVID-19 crisis(³¹31 Anmella G, Fico G, Roca A, Gómez-Ramiro M, Vázquez M, Murru A, et al. Unravelling potential severe psychiatric repercussions on healthcare professionals during the covid-19 crisis. J Affect Disord. 2020:273:422-4. https://doi.org/10.1016/j.jad.2020.05.061 https://doi.org/10.1016/j.jad.2020.05.06... )	2020 Spain	Case report/ n = 1	Does not apply	First reported case of severe mental illness in a healthcare professional with no prior psychiatric history due to COVID-19 outbreak
Allocating Scarce Resources and Triaging Patients during the COVID-19 Pandemic(³²32 Kirkpatrick JN, Hull SC, Fedson S, Mullen B, Goodlin SJ. Scarce-resources allocation and patient triaging during the covid-19 pandemic: JACC review topic of the week. J Am Coll Cardiol. 2020;76(1):85-92. https://doi.org/10.1016/j.jacc.2020.05.006 https://doi.org/10.1016/j.jacc.2020.05.0... )	2020 USA	Undefined / Does not apply	Does not apply	Practical recommendations for ethical screening management and clinical and ethical issues surrounding screening and rationing decisions
Prioritization of ICU treatments for critically ill patients in a COVID-19 pandemic with scarce resources(³³33 Leclerc T, Donat N, Donat A, Pasquier P, Libert N, Schaeffer E, et al. Prioritisation of ICU treatments for critically ill patients in a covid-19 pandemic with scarce resources. Anaesth Crit Care Pain Med. 2020;39(3):333-9. https://doi.org/10.1016/j.accpm.2020.05.008 https://doi.org/10.1016/j.accpm.2020.05.... )	2020 France	Undefined / Does not apply	Does not apply	Proposal of a strategy to prioritize scarce ICU resources during the COVID-19 pandemic

Source / Year	Title	Specification
Ministry of Health (2020)(³⁴34 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Boletim epidemiológico especial 17. Semana epidemiológica 21 [Internet]. 2020 [cited 2020 Jun 15]. Available from: https://www.saude.gov.br/images/pdf/2020/May/29/2020-05-25---BEE17---Boletim-do-COE.pdf https://www.saude.gov.br/images/pdf/2020... )	Coronavirus disease 2019	Epidemiological bulletin 17
EBSERH (2020)(³⁵35 Empresa Brasileira de Serviços Hospitalares (BR). Suporte em saúde mental em tempos de covid-19: guia de cuidados aos profissionais da saúde [Internet]. [Brasília, DF]: Ministério da Educação; 2020[cited 2020 May 4]. Available from: http://www2.ebserh.gov.br/documents/16756/5119444/A+cartilha+sau%CC%81de+mental+covid-19+ok.pdf/b277aed9-f881-45cd-b289-4457f33a0d85 http://www2.ebserh.gov.br/documents/1675... )	Mental health support in times of Covid-19	Guide
ANVISA (2020)(³⁶36 Agência Nacional de Vigilância Sanitária (BR). Nota técnica GVIMS/GGTES/ANVISA nº 04/2020. Orientações para serviços de saúde: medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo coronavírus (SARS-CoV-2) [Internet]. [Brasília, DF]: Anvisa; 2020[cited 2020 Jun 25]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/nota-tecnica-gvims_ggtes_anvisa-04_2020-25-02-para-o-site.pdf https://www.gov.br/anvisa/pt-br/centrais... )	Guidelines for health services: prevention and control measures that should be adopted during the care of suspected or confirmed cases of infection with the new coronavirus (Sars-CoV-2)	Technical note No. 4/2020
Ministry of Health (2020)(³⁷37 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Boletim epidemiológico 06. Doença pelo coronavírus 19 [Internet]. 2020 [cited 2020 May 17]. Available from: https://portalarquivos.saude.gov.br/images/pdf/2020/April/03/BE6-Boletim-Especial-do-COE.pdf https://portalarquivos.saude.gov.br/imag... )	Coronavirus disease 2019	Epidemiological bulletin 06
COFEN (2020)(³⁸38 Conselho Federal de Enfermagem. Observatório da Enfermagem. Profissionais infectados com Covid 19 informado pelos serviço de saúde [Internet]. [Brasília, DF]: Cofen [2020 cited 2020 May 21]. Available from: http://observatoriodaenfermagem.cofen.gov.br/ http://observatoriodaenfermagem.cofen.go... )	Nursing Observatory	Panel
Ministry of Health (2020)(³⁹39 Ministério da Saúde (BR). Recomendações de proteção aos trabalhadores dos serviços de saúde no atendimento de covid-19 e outras síndromes gripais [Internet]. [Brasília, DF]: MS; 2020[cited 2020 May 4]. Available from: https://profsaude-abrasco.fiocruz.br/sites/default/files/publicacoes/cgsat-recomendacoes-de-protecao-aos-trabalhadores-dos-servicos-de-saude-no-atendimento-de-covid-19.pdf https://profsaude-abrasco.fiocruz.br/sit... )	Recommendations for the protection of health service workers in the care of COVID-19 and other influenza syndromes	Guide
Ministry of Health (2020)(⁴⁰40 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Boletim epidemiológico 07. Especial: doença pelo coronavírus 19. Semana epidemiológica 15 [Internet]. 2020 [cited 2020 May 17]. Available from: https://portalarquivos.saude.gov.br/images/pdf/2020/April/06/2020-04-06-BE7-Boletim-Especial-do-COE-Atualizacao-da-Avaliacao-de-Risco.pdf https://portalarquivos.saude.gov.br/imag... )	Special: coronavirus disease 2019	Epidemiological bulletin 07

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[1] Corresponding author: Natalí Nascimento Gonçalves Costa, E-mail: natalicosta.fisio@gmail.com